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High-Grade Dysplasia in Resected Main-Duct Intraductal Papillary Mucinous Neoplasm (MD-IPMN) is Associated with an Increased Risk of Subsequent Pancreatic Cancer

Majumder, Shounak MD1; Philip, Nissy A. MBBS2; Singh Nagpal, Sajan Jiv MBBS1; Takahashi, Naoki MD3; Mara, Kristin C. MS4; Kendrick, Michael L. MD3; Smyrk, Thomas C. MD5; Zhang, Lizhi MD5; Levy, Michael J. MD1; Gleeson, Ferga C. MBBCh1; Petersen, Bret T. MD1; Pearson, Randall K. MD1; Topazian, Mark D. MD1; Vege, Santhi Swaroop MD1; Chari, Suresh T. MD1

American Journal of Gastroenterology: March 2019 - Volume 114 - Issue 3 - p 524–529
doi: 10.1038/s41395-018-0403-2
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BACKGROUND: There is lack of consensus on post-operative surveillance for resected non-invasive intraductal papillary neoplasms (IPMNs). In this study we explored risk factors for subsequent PC in patients with MD-IPMN undergoing partial pancreatectomy.

METHODS: We searched the Mayo Clinic surgical pathology database for all cases of resected MD-IPMN between 1997 and 2014. Cases with histologically confirmed main pancreatic duct involvement either isolated or in a mixed pattern with branch-duct involvement were included. Outcomes of PC in the remnant pancreas, and death related to MD-IPMN were assessed with survival analyses (Kaplan–Meier and Cox regression).

RESULTS: Among the 179 patients with resected MD-IPMN the incidence of concomitant PC and high-grade dysplasia (HGD) in the resected specimen was 23 and 14%, respectively. The mean duration of follow-up was 4.31 years (range 0.12–13.5 years). Excluding 28 subjects who either underwent initial total pancreatectomy or partial pancreatectomy with surgical margins positive for PC/HGD, the 5-year incidence of subsequent PC was 12%, including 60.6% and 15.6% in those with initial PC and HGD, respectively. The 10-year incidence of PC was 21.2% overall, 60.6% for PC, 38.3% for HGD, and 3.0% for LGD. Risk of subsequent PC was significantly higher for those with initial PC compared with HGD (HR = 4.95, 95% CI: 1.63–15.03, p = 0.005 and for HGD compared with LGD (HR = 11.30, 95% CI: 1.55–82.26, p = 0.017).

CONCLUSIONS: Patients with MD-IPMN with PC or HGD undergoing segmental pancreatectomy are at higher risk of subsequent PC and may benefit from post-operative surveillance. The post-operative surveillance intervals in resected MD-IPMNs need to be tailored based on dysplasia grade.

1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.

2Department of Internal Medicine, Saint Peter University Hospital, Trenton, NJ, USA.

3Division of Abdominal Imaging and Radiology, Mayo Clinic, Rochester, MN, 55905, USA.

4Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 55905, USA.

5Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, 55905, USA.

Correspondence: Shounak Majumder, MD. (E-mail: majumder.shounak@mayo.edu).

Received June 08, 2018

Accepted October 17, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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